Family Roles in Addiction & the Importance of Family Support in Recovery

The disease of addiction throws the family ecosystem out of balance. Spouses, children, and other loved ones are often the unintended victims of a person’s addiction and can fall into certain family roles of addiction. On the other hand, families can make a huge difference in their loved one’s recovery. Here you’ll learn why addiction is often called a family disease and how you can support your loved one in their recovery.

Defining Family

Family can be defined in many ways. When we talk about family, we don’t always mean the traditional nuclear family (mother, father, children).

Family can include the extended family (grandparents, cousins, aunts and uncles, etc.) It can also include individuals who are not biological family members but chosen family, e.g., godparents or close friends that serve as chosen family (sometimes called “fictive kin”).¹

Essentially, family includes those who have consistent emotional involvement in a person’s life. While families are usually connected by blood, they are almost always connected by strong emotional ties. In deciding who should be involved in family therapy, a counselor or therapist will often ask the client who is most important to them and who they consider family. Those people may then be invited to take part in family therapy sessions..¹

Addiction Impacts the Whole Family

Addiction is a pervasive disease. Its impact expends to all the people who love the individual with the SUD.² According to the American Society of Addiction Medicine (ASAM), addiction is even transmitted between families. For example, women married to women with addiction problems are more likely to become addicted themselves. Spouses who separate from addicted partners are more likely to reduce their own substance use.³

Effects of Addiction on Family Life

The family of someone struggling with a substance use disorder may suffer greatly alongside their loved one. As the disease of addiction develops and intensifies, family life tends to become chaotic. Family members may not know what to expect from day to day and may begin feeling helpless to change the situation.⁴ Families may experience problems including:²

• Emotional struggles.
• Financial difficulties.
• Legal issues.
• Violence.

Parental Substance Abuse Effects on Children

Children of individuals suffering from addiction may also have developmental needs that go unmet or develop unhealthy attachment patterns. They may also find themselves reversing roles with their parents and having to take on an inappropriate amount of responsibility. These children, as well as other family members, are also more likely to develop substance use disorders themselves.²

While families often bear the burden of the consequences of their loved one’s substance use disorder, they can also play a huge role in their family member’s recovery.

In many cases, the addicted person becomes unable to take care of themselves or their responsibilities in the way they used to, and one or more family members begin acting as a caregiver. The weight of being a caregiver is a heavy one, and it often comes with feelings of stress, anxiety, depression, fear, and anger. ⁴ Caregiving is also associated with an increased risk for mental health disorders such as depression.⁵

The good news is that while families often bear the burden of the consequences of their loved one’s substance use disorder, they can also play a huge role in their family member’s recovery. According to ASAM, family involvement in a person’s recovery from addiction has significant benefits for both the addicted patient and other members of the family.³

You can view the whole “Recovery is Relative” series here.

Common Roles in Families with Addiction

Being a member of a family where addiction is active is not easy. There are several emotions that develop at this time, many of which can be complicated to manage in a healthy manner. While everyone exhibits different reactions to having a family member with a substance use disorder, it is common for members of a family unit to fall into a role that either allows them to feel in control or helps them cope with the chaos surrounding them.

The Addicted Individual

The family member who is struggling with substance use can find themselves living in a continual state of disarray, as their primary focus remains on obtaining and using addictive substances. As a result, their behaviors can change to include the following:⁶ 

• Continued substance use despite any negative consequences that occur because of it
• Neglecting responsibilities at work, home, or school because of substance use
• Experiencing cravings for the substance(s)
• Developing tolerance, which occurs when an individual must increase the amount of substance they are using to achieve the desired effects
• Experiencing withdrawal symptoms when unable to use

The Enabler/Caretaker 

The enabler, or caretaker, in the family where addiction is occurring is often the individual who is attempting to protect the family member with an SUD from the negative effects of their substance use. Rather than allowing them to experience the impacts of their use, the enabler personally handles the impacts instead. They may also neglect their own needs in order to care for the family member with an SUD.¹

The Hero

The role of the hero is most commonly taken on by the oldest child in the family unit. Similar to the enabler, the hero strives to take care of the individual with an SUD and has a sense of responsibility for them and their actions. The rest of the family may rely on them, which can cause the hero to feel overwhelmed.¹ 

The Scapegoat

When addiction is affecting a family unit, the scapegoat becomes the one who distracts everyone’s attention away from the individual with the SUD by developing negative behaviors. Despite witnessing the effects of addiction, the scapegoat is the family member who is most likely to participate in substance use themselves. This can lead to increased risk for future personal and professional problems to develop.¹

The Mascot

The mascot makes attempts to avoid further distress by distracting the family with humor or charm. Unfortunately, this coping mechanism often creates complications in adulthood, as they may struggle with handling problems effectively and developing healthy relationships.¹

The Lost Child

The lost child often does not get their needs met or their achievements recognized by other members of the family. They may isolate themselves from their family and experience loneliness and sadness. The lost child tends to lack relationships with others.¹

The Importance of Family Support in Recovery

Family members and loved ones of those dealing with addiction or another mental health disorder play important roles. Family support in addiction recovery may look like:⁴

• Intervening in a crisis situation.
• Finding treatment options and helping them get into treatment.
• Providing necessary information about their life and substance use that will help the treatment professionals provide the right type of care.
• Maintaining health records and providing them to treatment providers as necessary.
• Advocating for their needs and rights.
• Helping them stick with their treatment and aftercare plans and watching for any significant behavioral changes that may signal an impending relapse.

Your involvement has so many benefits for your loved one. Studies show that when families take part in the treatment and recovery process, the recovering person is:⁴

• Less likely to be hospitalized or experience a relapse.
• More likely to adhere to treatment.
• More likely to recover from the disorder.
• Less likely to be involved in the criminal justice system.

Family members themselves can also benefit from taking part in the treatment process. They may receive education on the disease of addiction and learn healthy coping strategies to be positive contributors to their loved one’s recovery efforts.⁴

Many treatment programs invite families into the treatment process through scheduled family visits, family classes, and even family therapy. When major issues in the family improve, the recovering person may be more likely to stay in recovery, and other family members may be less likely to struggle with the same problems in the future.¹

How Can I Help My Loved One’s Recovery?

Recovery is a lifelong process that requires daily work from your loved one, but you can also play a role in this journey. While you may not know exactly how to help a family member with addiction, there are plenty of ways you can support them.

Take Part in Treatment

While your family member is in treatment, they may have opportunities for you to come visit them at scheduled times. Providing your family member is open to it, take advantage of these opportunities and attempt to hold back on expressing your resentments about things that happened in the past. Express your support and pride that they are getting the help they need to break the hold the disease of addiction has on their life.

What if I Can’t Visit?

In some cases, you might not be able to make it to the treatment program for a visit. This may be due to financial constraints, personal obligations at home, or sickness. In-person family visits may even be put on hold at certain times, such as during the COVID-19 pandemic where social distancing is encouraged or mandated. In these cases, you may be able to support your family member with regular phone, Skype, or Facetime calls. Laguna Treatment Hospital offers the option of family therapy via telephone or Skype.

In some cases, your family member may not want to communicate. This is okay. Try to respect their wishes and get support for yourself while they work on their recovery.

Get Help for Yourself

Addiction and mental health disorders have effects that extend far beyond the individual, and you may have spent a great deal of time feeling exhausted, resentful, angry, worried, or depressed. You may also have developed some unhealthy ways of adjusting to the changes addiction has created in your life.

While your family member is in treatment, you can do some work on your own to gain support, improve your coping skills, learn how to avoid enabling, and be better prepared overall when your loved one comes home from rehab. You’ll meet others who are going through or have gone through similar situations who can offer you support and an understanding ear.

Some mutual-help options for you to check out include:

• Al-Anon.
• Nar-Anon.
• Codependents Anonymous.
• National Alliance on Mental Illness (NAMI) Family Support Groups.

If you’re unable to leave home for any reason, there are ways to attend virtual meetings. For example, In the Rooms offers many types of remote support groups for family members. You may also consider attending individual therapy or counseling on your own.

Avoid Enabling

Enabling refers to actions that allow destructive behavior to continue. Enabling is common among families and loved ones of addicted persons. When you love someone, it’s your instinct to protect them. Unfortunately, attempting to protect your family member can allow them to avoid the natural consequences of their addiction that might motivate them to change.²

Instead of enabling your loved one’s substance use by helping them avoid the consequences, you can motivate them to make better choices by consistently bringing up the issue of treatment and creating healthy boundaries for yourself. Many of the groups mentioned above, especially Codependents Anonymous, can help you learn the difference between helping and enabling and provide tips on creating healthy boundaries.

Should I Let My Family Member Leave Rehab Early?

Often, recovery from addiction involves many tries. Giving up a mind-altering substance is incredibly difficult for many people, especially when withdrawal is painful and when they are no longer able to suppress negative emotions with the substance.

Your loved one may be motivated when they enter treatment but become overwhelmed or frightened as they progress in the program. Loved ones may receive calls from the patient begging them to come pick them up and let them leave.

It’s hard to hear your loved one in distress, and you may be tempted to come collect them, but it could be dangerous or even deadly for them to leave. Individuals in the first days of being clean, specifically those who are opioid-dependent, may have lost their tolerance and may suffer an overdose should they return home and attempt to use their normal amount again.⁷

You can’t control your family member’s life, but you may have leverage to keep them in treatment. This may include financial or legal assistance, a place for them to reside, or other means of support.

Families of Laguna Treatment Hospital Patients

At our Orange County drug detox facility, we want you to be a part of your loved one’s recovery process. We invite you to visit your family member during treatment and will work with you to schedule a convenient time. We also invite you to work with your loved one in family therapy.

To learn more about where to come for visits, nearby hotels and accommodations, transportation options, and more, visit our What to Expect page for families.

If you love someone who is not yet in treatment and you need help, feel free to give us a call today at . We are here to guide both you and your loved one through the next steps, including the treatment admissions process and paying for treatment. Stop waiting and get help today.

References:

1. Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 1 Substance Abuse Treatment and Family Therapy.
2. Lander, L., Howsare, J., & Byrne, M. (2013). The impact of substance use disorders on families and children: from theory to practice. Social work in public health, 28(3-4), 194–205.
3. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
4. Centre for Addiction and Mental Health. (2006). Caring Together: Families as Partners in the Mental Health and Addiction System.
5. American Psychological Association. (n.d.). Mental Health of Caregivers.
6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Arlington, VA: American Psychiatric Association.
7. Joudrey, P.J., Khan, M.R., Wang, E.A. et al.A conceptual model for understanding post-release opioid-related overdose risk. Addict Sci Clin Pract 14, 17 (2019).